CTR to Claim Out Mappings

This document describes how a Claim Transaction is mapped to xml output as used in for example the response messages of the CTR Claims Out Integration Point.

Claim

Message element, Attribute Entity, Field

<claimHeader authorizationCode>

ctrClaim.AuthorizationCode

<claimHeader claimDate>

ctrClaim.ClaimDate

<claimHeader classificationSchemeCode>

ctrClaim.ClassificationSchemeCode

<claimHeader classificationCode>

ctrClaim.ClassificationCode

<claimHeader code>

ctrClaim.Code

<claimHeader createdDate>

audit field

<claimHeader creationBy>

audit field

<claimHeader dataAccessGroupAccessCode>

ctrClaim.DataAccessGroupAccessCode

<claimHeader dataAccessGroupCode>

ctrClaim.DataAccessGroupCode

<claimHeader dueDate>

ctrClaim.DueDate

<claimHeader endDate>

ctrClaim.EndDate

<claimHeader entryDate>

ctrClaim.EntryDate

<claimHeader formCode>

ctrClaim.FormCode

<claimHeader formDescription>

ctrClaim.FormDescription

<claimHeader indEmergency>

ctrClaim.EmergencyIndicator

<claimHeader indIgnoreHistory>

ctrClaim.IgnoreHistoryIndicator

<claimHeader indManual>

ctrClaim.ManualIndicator

<claimHeader indReversal>

ctrClaim.Reversal

<claimHeader lastUpdatedBy>

audit field

<claimHeader lastUpdatedDate>

audit field

<claimHeader nextPayerCode>

ctrClaim.NextPayerCode

<claimHeader objectLastUpdatedBy>

audit field

<claimHeader objectLastUpdatedDate>

audit field

<claimHeader payerCode>

ctrClaim.PayerCode

<claimHeader precedingPayerCode>

ctrClaim.PrecedingPayerCode

<claimHeader precedingPayerPaidDate>

ctrClaim.PaidDate

<claimHeader priceDate>

ctrClaim.PriceDate

<claimHeader providerEntityReference>

ctrClaim.ProviderEntityReference

<claimHeader providerReference>

ctrClaim.ProviderReference

<claimHeader receiptDate>

ctrClaim.ReceiptDate

<claimHeader serviceSpecialtyCode>

ctrClaim.ServiceSpecialtyCode

<claimHeader startDate>

ctrClaim.StartDate

<claimHeader status>

ctrClaim.Status

<claimHeader><totalAllowedAmount amount>

ctrClaim.TotalAllowedAmount

<claimHeader><totalAllowedAmount currencyCode>

ctrClaim.TotalAllowedAmountCurr

<claimHeader><totalClaimedAmount amount>

ctrClaim.TotalClaimedAmount

<claimHeader><totalClaimedAmount currencyCode>

ctrClaim.TotalClaimedAmountCurr

<claimHeader><totalCoveredAmount amount>

ctrClaim.TotalCoveredAmount

<claimHeader><totalCoveredAmount currencyCode>

ctrClaim.TotalCoveredAmountCurr

<claimHeader transactionDateTime>

ctrClaim.TransactionDateTime

<claimHeader claimSetCode>

ctrClaim.ClaimSetCode

<claimHeader type>

ctrClaim.Type

<claimHeader version>

ctrClaim.Version

<brand accessCode>

ctrClaim.BrandAccessCode

<brand code>

ctrClaim.BrandCode

<brand description>

ctrClaim.BrandDescription

<brand payerAccessCode>

ctrClaim.BrandPayerAccessCode

<brand payerName>

ctrClaim.BrandPayerName

<claimant accessCode>

ctrClaim.ClaimantAccessCode

<claimant contactAccessCode>

ctrClaim.ClaimantContactAccessCode

<claimant flexCodeDefinitionCode>

ctrClaim.ClaimantProvCodeDef

<claimant name>

ctrClaim.ClaimantName

<claimant providerCode>

ctrClaim.ClaimantProvCode

<claimant relationCode>

ctrClaim.ClaimantRelCode

<paymentBeneficiary flexCodeDefinitionCode>

ctrClaim.PayBeneficiaryProvCodeDef

<paymentBeneficiary name>

ctrClaim.PayBeneficiaryName

<paymentBeneficiary providerCode>

ctrClaim.PayBeneficiaryProvCode

<paymentBeneficiary relationCode>

ctrClaim.PayBeneficiaryRelCode

<paymentReceiver flexCodeDefinitionCode>

ctrClaim.PayReceiverProvCodeDef

<paymentReceiver name>

ctrClaim.PayReceiverName

<paymentReceiver providerCode>

ctrClaim.PayReceiverProvCode

<paymentReceiver relationCode>

ctrClaim.PayReceiverRelCode

<referralProvider flexCodeDefinitionCode>

ctrClaim.ReferralProvCodeDef

<referralProvider name>

ctrClaim.ReferralProvName

<referralProvider providerCode>

ctrClaim.ReferralProvCode

<serviceProvider flexCodeDefinitionCode>

ctrClaim.ServiceProvCodeDef

<serviceProvider name>

ctrClaim.ServiceProvName

<serviceProvider providerCode>

ctrClaim.ServiceProvCode

<paymentSpecificationReceiver flexCodeDefinitionCode>

ctrClaim.SpecReceiverProvCodeDef

<paymentSpecificationReceiver name>

ctrClaim.SpecReceiverName

<paymentSpecificationReceiver providerCode>

ctrClaim.SpecReceiverProvCode

<paymentSpecificationReceiver relationCode>

ctrClaim.SpecReceiverRelCode

<internalRemarks>

ctrClaim.InternalRemarks

<externalRemarks>

ctrClaim.ExternalRemarks

<statusHistoryEntry dateTime>

ctrStatusHistory.StatusDateTime

<statusHistoryEntry status>

ctrStatusHistory.Status

<statusHistoryEntry userLoginName>

ctrStatusHistory.UserLoginName

<calloutHistoryEntry definitionCode>

ctrCalloutHistory.definitionCode

<calloutHistoryEntry definitionDescription>

ctrCalloutHistory.definitionDescription

<calloutHistoryEntry requestSentDatetime>

ctrCalloutHistory.requestSentDatetime

<calloutHistoryEntry responseReceivedDatetime>

ctrCalloutHistory.responseReceivedDatetime

<pendReasonHistoryEntry billProviderReference>

ctrPendReasonHistory.BillProviderReference

<pendReasonHistoryEntry claimLineCode>

ctrPendReasonHistory.ClaimLineCode

<pendReasonHistoryEntry code>

ctrPendReasonHistory.Code

<pendReasonHistoryEntry externalCode>

ctrPendReasonHistory.ExternalCode

<pendReasonHistoryEntry alternativeText>

ctrPendReasonHistory.AlternativeText

<pendReasonHistoryEntry providerText>

ctrPendReasonHistory.ProviderText

<transactionLabel creationDate>

ctrTransactionLabel.CreationDate

<transactionLabel dateTime>

ctrTransactionLabel.LabelDateTime

<transactionLabel type>

ctrTransactionLabel.LabelType

<diagnosis accessCode>

ctrClaimDiagnosis.AccessCode

<diagnosis code>

ctrClaimDiagnosis.Code

<diagnosis flexCodeDefinitionCode>

ctrClaimDiagnosis.CodeDef

<diagnosis description>

ctrClaimDiagnosis.Description

<diagnosis sequence>

ctrClaimDiagnosis.Sequence

<diagnosis type>

ctrClaimDiagnosis.TypeCode

<diagnosis typeDescription>

ctrClaimDiagnosis.TypeDescription

<message code>

ctrClaimMessage.Code

<message externalCode>

ctrClaimMessage.ExternalCode

<message alternativeMessageText>

ctrClaimMessage.AlternativeMessageText

<message messageText>

ctrClaimMessage.MessageText

<message origin>

ctrClaimMessage.Origin

<message priority>

ctrClaimMessage.Priority

<message providerMessageText>

ctrClaimMessage.ProviderMessageText

<message referenceCode>

ctrClaimMessage.ReferenceCode

<message severity>

ctrClaimMessage.Severity

<message transactionSourceCode>

ctrClaimMessage.TransactionSourceCode

<message overturned

ctrClaimMessage.OverturnedIndicator

<message overturnedBy

ctrClaimMessage.OverturnedBy

<unfinalizeReason code>

ctrClaimUnfinalizeReason.Code

<unfinalizeReason externalCode>

ctrClaimUnfinalizeReason.ExternalCode

<unfinalizeReason sourceReference>

ctrClaimUnfinalizeReason.ReferenceCode

<locationType code>

ctrClaim.LocationTypeCode

<locationType description>

ctrClaim.LocationTypeDescription

ClaimLine

The mapping of a Claim Transaction Claim Line to an xml response is described in the following table.

Message element, attribute Entity, field

<claimLine><AllowedAmount amount>

ctrClaimLine.AllowedAmount

<claimLine><AllowedAmount currencyCode>

ctrClaimLine.AllowedAmountCurr

<claimLine AllowedNumberOfUnits>

ctrClaimLine.AllowedNumberOfUnits

<claimLine AuthorizationCode>

ctrClaimLine.AuthorizationCode

<claimLine><claimLineOverride AuthorizationRegimeCode>

ctrClaimLine.AuthorizationRegimeCode

<claimLine><authorizationExceptionType >

ctrClaimLine.AuthorizationExceptionType

<claimLine BenefitsAgeInputDate>

ctrClaimLine.BenefitsAgeInputDate

<claimLine><BenefitsInputAmount amount>

ctrClaimLine.BenefitsInputAmount

<claimLine><BenefitsInputAmount currencyCode>

ctrClaimLine.BenefitsInputAmountCurr

<claimLine BenefitsInputDate>

ctrClaimLine.BenefitsInputDate

<claimLine ClaimDate>

ctrClaimLine.ClaimDate

<claimLine><ClaimedAmount amount>

ctrClaimLine.ClaimedAmount

<claimLine><ClaimedAmount currencyCode>

ctrClaimLine.ClaimedAmountCurr

<claimLine ClaimedNumberOfUnits>

ctrClaimLine.ClaimedNumberOfUnits

<claimLine ClassificationCode>

ctrClaimLine.ClassificationCode

<claimLine ClassAuthorizationCode>

ctrClaimLine.ClassAuthorizationCode

<claimLine.claimLineOverride CoverageRegimeCode>

ctrClaimLine.CoverageRegimeCode

<claimLine><claimLineOverride CoverageRegimeCodeNoAuth>

ctrClaimLine.CoverageRegimeCodeNoAuth

<claimLine><claimLineOverride CoverageSpecificationCode>

ctrClaimLine.CoverageSpecificationCode

<claimLine><CoveredAmount amount>

ctrClaimLine.CoveredAmount

<claimLine><CoveredAmount currencyCode>

ctrClaimLine.CoveredAmountCurr

<claimLine CoveredNumberOfUnits>

ctrClaimLine.CoveredNumberOfUnits

<claimLine createdBy>

audit field

<claimLine creationDate>

audit field

<claimLine EndDate>

ctrClaimLine.EndDate

<claimLine><claimLineOverride FamilyCode>

ctrClaimLine.FamilyCode

<claimLine><claimLineOverride FundingArrangementCode>

ctrClaimLine.FundingArrangementCode

<claimLine IndEmergency>

ctrClaimLine.EmergencyIndicator

<claimLine IndEncounter>

ctrClaimLine.EncounterIndicator

<claimLine IndPricePrincipalProcedure1>

ctrClaimLine.PricePrincipalProc1Ind

<claimLine IndPricePrincipalProcedure2>

ctrClaimLine.PricePrincipalProc2Ind

<claimLine IndPricePrincipalProcedure3>

ctrClaimLine.PricePrincipalProc3Ind

<claimLine IndReplaced>

ctrClaimLine.ReplacedIndicator

<claimLine lastUpdatedBy>

audit field

<claimLine lastUpdatedDate>

audit field

<claimLine><claimLineOverride PostBenefitsRegimeCode>

ctrClaimLine.PostBenefitsRegimeCode

<claimLine><PrecedingPayerPaidAmount amount>

ctrClaimLine.PrecedingPayerPaidAmount

<claimLine><PrecedingPayerPaidAmount currencyCode>

ctrClaimLine.PrecPayerPaidAmountCurr

<claimLine PriceInputDate>

ctrClaimLine.PriceInputDate

<claimLine PriceInputNumberOfUnits>

ctrClaimLine.PriceInputNumberOfUnits

<claimLine ProcessAsIn>

ctrClaimLine.ProcessAsIn

<claimLine><claimLineOverride ProductCode>

ctrClaimLine.ProductCode

<claimLine><claimLineOverride ProductFamilyCode>

ctrClaimLine.ProductFamilyCode

<claimLine><claimLineOverride ProductLineCode>

ctrClaimLine.ProductLineCode

<claimLine ProviderEntityReference>

ctrClaimLine.ProviderEntityReference

<claimLine ProviderReference>

ctrClaimLine.ProviderReference

<claimLine ReplacedByCode>

ctrClaimLine.ReplacedByCode

<claimLine ReplacesCode>

ctrClaimLine.ReplacesCode

<claimLine Sequence>

ctrClaimLine.Sequence

<claimLine ServiceSpecialtyCode>

ctrClaimLine.ServiceSpecialtyCode

<claimLine StartDate>

ctrClaimLine.StartDate

<claimLine Status>

ctrClaimLine.Status

<claimLine><claimLineOverride SubscriptionDate>

ctrClaimLine.SubscriptionDate

<claimLine><claimLineOverride WaitingPeriodRegimeCode>

ctrClaimLine.WaitingPeriodRegimeCode

<claimLine WaitingPeriodInputDate>

ctrClaimLine.WaitingPeriodInputDate

<claimLine Code>

ctrClaimLine.Code

<claimLine><Coverage Action>

ctrClaimLineCoverage.Action

<claimLine><Coverage> <Amount amount>

ctrClaimLineCoverage.Amount

<claimLine><Coverage> <Amount currencyCode>

ctrClaimLineCoverage.AmountCurr

<claimLine><Coverage CoverageLabelCode>

ctrClaimLineCoverage.CoverageLabelCode

<claimLine><Coverage NumberOfUnits>

ctrClaimLineCoverage.NumberOfUnits

<claimLine><Diagnosis AccessCode>

ctrClaimLineDiagnosis.AccessCode

<claimLine><Diagnosis Code>

ctrClaimLineDiagnosis.Code

<claimLine><Diagnosis FlexCodeDefinitionCode>

ctrClaimDiagnosis.CodeDef

<claimLine><Diagnosis Description>

ctrClaimLineDiagnosis.Description

<claimLine><Diagnosis Sequence>

ctrClaimLineDiagnosis.Sequence

<claimLine><Diagnosis Type>

ctrClaimLineDiagnosis.TypeCode

<claimLine><Diagnosis TypeDescription>

ctrClaimLineDiagnosis.TypeDescription

<claimLine><benefitsProvider name>

ctrClaimLine.benefitsProvName

<claimLine><benefitsProvider providerCode>

ctrClaimLine.benefitsProvCode

<claimLine><benefitsProvider flexCodeDefinitionCode>

ctrClaimLine.benefitsProvCodeDef

<claimLine><Procedure accessCode>

ctrClaimLine.ProcedureAccessCode

<claimLine><Procedure code>

ctrClaimLine.ProcedureCode

<claimLine><Procedure flexCodeDefinitionCode>

ctrClaimLine.ProcedureFlexCodeDefintionCode

<claimLine><Procedure description>

ctrClaimLine.ProcedureDescription

<claimLine><providerPricingClause sequence>

ctrClaimLineProviderPricingClause.sequence

<claimLine><providerPricingClause methodRuleType>

ctrClaimLineProviderPricingClause.methodRuleType

<claimLine><providerPricingClause providerPricingClauseDescription>

ctrClaimLineProviderPricingClause.providerPricingClauseDescription

<claimLine><providerPricingClause quantifier>

ctrClaimLineProviderPricingClause.quantifier

<claimLine><providerPricingClause methodRuleCode>

ctrClaimLineProviderPricingClause.methodRuleCode

<claimLine><providerPricingClause mark>

ctrClaimLineProviderPricingClause.mark

<claimLine><providerPricingClause> <amount amount>

ctrClaimLineProviderPricingClause.amount

<claimLine><providerPricingClause> <amount currencyCode>

ctrClaimLineProviderPricingClause.amountCurr

<claimLine><referralProvider name>

ctrClaimLine.referralProvName

<claimLine><referralProvider providerCode>

ctrClaimLine.referralProvCode

<claimLine><referralProvider flexCodeDefinitionCode>

ctrClaimLine.referralProvCodeDef

<claimLine><serviceProvider name>

ctrClaimLine.serviceProvName

<claimLine><serviceProvider providerCode>

ctrClaimLine.serviceProvCode

<claimLine><serviceProvider flexCodeDefinitionCode>

ctrClaimLine.serviceProvCodeDef

<claimLine><locationProvider name>

ctrClaimLine.locationProvName

<claimLine><locationProvider providerCode>

ctrClaimLine.locationProvCode

<claimLine><locationProvider flexCodeDefinitionCode>

ctrClaimLine.locationProvCodeDef

<claimLine><paymentReceiver name>

ctrClaimLine.payReceiverName

<claimLine><paymentReceiver relationCode>

ctrClaimLine.payReceiverRelCode

<claimLine><paymentReceiver providerCode>

ctrClaimLine.payReceiverProvCode

<claimLine><paymentReceiver flexCodeDefinitionCode>

ctrClaimLine.payReceiverProvCodeDef

<claimLine><priceIndividualProvider name>

ctrClaimLine.priceIndProvName

<claimLine><priceIndividualProvider providerCode>

ctrClaimLine.priceIndProvProvCode

<claimLine><priceIndividualProvider flexCodeDefinitionCode>

ctrClaimLine.priceIndProvProvCodeDef

<claimLine><priceOrganizationProvider name>

ctrClaimLine.priceOrgProvName

<claimLine><priceOrganizationProvider providerCode>

ctrClaimLine.priceOrgProvProvCode

<claimLine><priceOrganizationProvider flexCodeDefinitionCode>

ctrClaimLine.priceOrgProvCodeDef

<claimLine><locationType code>

ctrClaimLine.LocationTypeCode

<claimLine><locationType description>

ctrClaimLine.LocationTypeDescription

<claimLine><benefitSpecification benefitSpecificationCode>

ctrClaimLineBenefitSpecification.benefitSpecificationCode

<claimLine><benefitSpecification benefitSpecificationSubtype>

ctrClaimLineBenefitSpecification.benefitSpecificationSubtype

<claimLine><benefitSpecification regimeCode>

ctrClaimLineBenefitSpecification.regimeCode

<claimLine><benefitSpecification productCode>

ctrClaimLineBenefitSpecification.productCode

<claimLine><benefitSpecification productProviderGroupStatus>

ctrClaimLineBenefitSpecification.productProviderGroupStatus

<claimLine><benefitSpecification productProviderGroupCode>

ctrClaimLineBenefitSpecification.productProviderGroupCode

<claimLine><benefitSpecification specificProviderGroupStatus>

ctrClaimLineBenefitSpecification.specificProviderGroupStatus

<claimLine><benefitSpecification specificProviderGroupCode>

ctrClaimLineBenefitSpecification.specificProviderGroupCode

<claimLine><benefitSpecification inheritedProviderGroupStatus>

ctrClaimLineBenefitSpecification.inheritedProviderGroupStatus

<claimLine><benefitSpecification processedAsIn>

ctrClaimLineBenefitSpecification.processedAsIn

<claimLine><appliedParameterPercentage

ctrClaimLineAppliedParameter.percentage

<claimLine><appliedParameterAmountPerUnit

ctrClaimLineAppliedParameter.amountPerUnit

<claimLine><appliedParameterAmountPerUnitCurrency

ctrClaimLineAppliedParameter.amountPerUnitCurrency

<claimLine><appliedParameterBenefitSpecificationCode

ctrClaimLineAppliedParameter.benefitSpecificationCode

<claimLine><appliedParameterProductCode

ctrClaimLineAppliedParameter.productCode

<claimLine><appliedParameterCoverWithholdCategoryCode

ctrClaimLineAppliedParameter.coverWithholdCategoryCode

<claimLine><appliedParameterMaximumAmount

ctrClaimLineAppliedParameter.maximumAmount

<claimLine><appliedParameterMaximumAmountCurrency

ctrClaimLineAppliedParameter.maximumAmountCurrency

<claimLine><appliedParameterMaximumServiceDays

ctrClaimLineAppliedParameter.maximumServiceDays

<claimLine><appliedParameterMaximumNumber

ctrClaimLineAppliedParameter.maximumNumber

<claimLine><appliedParameterAliasCode

ctrClaimLineAppliedParameter.aliasCode

<claimLine><appliedParameterLimitCode

ctrClaimLineAppliedParameter.limitCode

<claimLine><appliedParameterReachedAction

ctrClaimLineAppliedParameter.reachedAction

Dynamic Fields

For any object that can have dynamic fields, its dynamic fields are output in an element named 'dynamicFields', which is contained in the element for the corresponding object. For any such object the structure of the dynamicFields element is the same. For dynamic fields that are not time valid the attributes startDate and endDate will not be present. For dynamic fields that are free fields the attribute flexCodeDefinitionCode will not be present.

Message element, attribute Entity, field

<dynamicField name>

The 'Field Usage Name' of the Dynamic Field Usage

<dynamicField><value startDate>

The startDate of a time valid dynamic field

<dynamicField><value endDate>

The endDate of a time valid dynamic field

<dynamicField><value flexCodeDefinitionCode>

The code of the Flex Code Definition

<dynamicField><value> (textNode)

The text node within the value element holds the value stored in the dynamic field.

Dynamic Records

For any object that can have dynamic records, its dynamic records are output in an element named 'dynamicRecords', which is contained in the element for the corresponding object. For any such object the structure of the dynamicRecords element is the same.

Dynamic records that are not time valid have exactly one row. In this row the attributes startDate and endDate will not be present. Dynamic records that are time valid have one row for every time period and every row has the attribute startDate. Every row element contains a number of column elements which correspond to the columns defined in the flex code field usage of the dynamic record definition.

Message element, Attribute Entity, Field

<dynamicRecordTable>

The 'Field Usage Name' of the Dynamic Record Usage

<dynamicRecordTable><row startDate>

The startDate of a time valid dynamic record

<dynamicRecordTable><row endDate>

The endDate of a time valid dynamic record

<dynamicRecordTable><row><column name>

corresponds to one of the codes of the Flex Code Field Usage of the dynamic record definition.

<dynamicRecordTable><row><column> (textNode)

The text node within the column element holds the value stored in this column of the dynamic record.